Transcatheter Aortic Valve Replacement (TAVR) refers to a minimally invasive
procedure used to replace the aortic valve.
Why does the aortic valve need to be replaced?
As the heart muscle ages, the aortic valve can develop wear and tear from
constant use. Calcium begins to deposit on the valve, which leads to “stenosis,”
which is narrowing of the valve. When the narrowing becomes severe, the
heart must work extra hard to pump blood to the brain and the rest of
the body. Patients may develop symptoms including shortness of breath,
chest pain, or a lack of energy when performing everyday tasks.
What are the steps prior to the procedure?
There are several tests that need to be completed prior to a TAVR procedure.
Many of these tests are required by Medicare and insurance companies.
The main testing includes:
- Coronary angiogram: A procedure where dye is injected into the arteries
of the heart to check for major blockages. We need to make sure these
arteries are clear before working on the heart valve.
- CT Angiogram: A specialized CAT scan to recreate each patient’s aortic
valve; this ensures that each patient receives the right size TAVR valve.
- Consultation with cardiac surgeon: All patients will need to visit with
a cardiac surgeon. Some patients may be a better candidate for open heart
surgery, and all TAVR procedures are performed in conjunction with a cardiac
surgeon. We collaborate with the cardiac surgeon to determine the best
valve and approach.
How is the procedure performed?
Engineers developed a heart valve that can be mounted on a balloon, which
allows it to be inserted into the femoral artery and advanced inside the
stenotic aortic valve. Once in position, the valve is then expanded up
to 5 times larger, and the new valve functions immediately.
Procedures take place in the cardiac cath lab, where we have special X
ray equipment. An anesthesiologist administers deep sedation. We use sedation
instead of general anesthesia as it provides a quick recovery time after
the case and allows for a pain free procedure.
We start by placing a catheter (tube) into the femoral artery, which is
the main artery in the leg just above the hip. Through this tube, we advance
a wire and guide it across the narrowed aortic valve. With the wire in
place, we insert a new heart valve inside the existing narrowed heart
valve. The balloon is then expanded, leaving a new heart brand valve in
place. We then remove the balloon and wire, and finish by closing the
hole in the femoral artery with stitches. The procedure takes about 30-45 minutes.
What is the recovery like?
The recovery from TAVR is relatively quick, particularly when compared
to alternatives such as open heart surgery. We use moderate sedation during
the case, and patients are awake 15-20 minutes after the procedure. Patients
are admitted to a hospital room and monitored closely. Patients will lie
flat for 4-5 hours, then can sit upright in a chair. The majority of our
patients are discharged after a one night observation in the hospital.
After discharge, patients can resume everyday activity, including walking.
We recommend no heavy lifting for at least one week to give the artery
time to heal. Bruising around the femoral artery is normal, as a small
amount of blood may leak out into the soft tissue. This blood will be
totally recycled, but it may take 3-4 weeks for the discoloration from
bruising to resolve. It is ok to shower, but we recommend avoiding a bath
until the puncture site has healed.
St. Joseph Hospital TAVR program
The TAVR program at St. Joseph Hospital is the highest volume program in
Orange County, with over 600 successful procedures since 2016.
Dr. Aidan R. Raney received expert training in TAVR during a 2 year fellowship at the prestigious
Scripps Clinic in San Diego. He performed the first TAVR at St. Joseph
Hospital in 2016.
Dr. Eugene Byun joined Dr. Raney shortly thereafter, and together the physicians perform
over 200 valve procedures per year.
Outcomes at St. Joseph hospital consistently rank in the top 10% nationally.
St. Jude Hospital TAVR program
Dr. Byun and Dr. Raney started the program at St. Jude Hospital in 2019
in response to increased demand for aortic valve replacement in Orange
County and the surrounding area. The team includes St. Jude’s cardiothoracic
surgeon, Dr. Taylor Tang, in addition to the staff that has performed
hundreds of procedures at St. Joseph’s Hospital.